Provider Demographics
NPI:1780703645
Name:CONROY EYE CARE, PA
Entity type:Organization
Organization Name:CONROY EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-839-2608
Mailing Address - Street 1:217 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1491
Mailing Address - Country:US
Mailing Address - Phone:320-839-2608
Mailing Address - Fax:320-839-2601
Practice Address - Street 1:217 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1491
Practice Address - Country:US
Practice Address - Phone:320-839-2608
Practice Address - Fax:320-839-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00048426OtherRAILROAD MEDICARE
MN377725100Medicaid
MNU71510Medicare UPIN
MN4758330001Medicare NSC
MN410001866Medicare ID - Type Unspecified
MN410001867Medicare ID - Type Unspecified